Graphical Abstract:

Abstract:

Background: Although, some clinical trials investigated the maternal and neonatal effect
of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best
of our knowledge, there is no systematic review to summarize these results.

Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal
effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean
section.

Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July
2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a
premedication before induction of general anesthesia compared with placebo on neonate first and
fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section.
Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity
analysis.

Results: The present systematic review and meta-analysis consisted of three clinical trials including
180 women in labor. Considering the results of meta-analysis, there is no significant differences
between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5
minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: -
0.98, -0.38, p<0.001). In the term of maternal hemodynamics, the heart rate (SMD -0.43, 95%CI: -
0.72, -0.13, p=0.004) and MAP (SMD -0.78, 95% CI: -1.09, -0.48, p<0.001) in fentanyl group were
significantly lower compared with placebo group.

Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication
before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had
positive effects on preventing adverse consequences of intubation on maternal hemodynamics.

Affiliation:Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Children`s Medical Center, Tehran University of Medical Sciences, Tehran, Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz

Background: Although, some clinical trials investigated the maternal and neonatal effect
of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best
of our knowledge, there is no systematic review to summarize these results.

Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal
effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean
section.

Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July
2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a
premedication before induction of general anesthesia compared with placebo on neonate first and
fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section.
Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity
analysis.

Results: The present systematic review and meta-analysis consisted of three clinical trials including
180 women in labor. Considering the results of meta-analysis, there is no significant differences
between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5
minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: -
0.98, -0.38, p<0.001). In the term of maternal hemodynamics, the heart rate (SMD -0.43, 95%CI: -
0.72, -0.13, p=0.004) and MAP (SMD -0.78, 95% CI: -1.09, -0.48, p<0.001) in fentanyl group were
significantly lower compared with placebo group.

Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication
before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had
positive effects on preventing adverse consequences of intubation on maternal hemodynamics.